Medicare and Medicaid
At the top of President Lyndon Johnson’s legislative agenda in 1965 was Medicare, a federally funded insurance program to provide low-cost medical and hospital care for America’s elderly under Social Security. Half of the country’s population over age sixty-five had no medical insurance, and a third of the aged lived in poverty, unable to afford proper medical care; Johnson believed it was high time to do something about this.
Shortly after his November election win, he told Health, Education, and Welfare’s assistant secretary, Wilbur Cohen, to make Medicare the administration’s "number one priority." On January 4, Johnson put the issue front and center in his State of the Union message (full text); three days later he pressed for passage of Medicare, issuing a statement to Congress demanding that America’s senior citizens "be spared the darkness of sickness without hope."
Franklin Roosevelt was the first president to seriously consider a federal health insurance program. As Congress churned out New Deal legislation, Roosevelt advocated inclusion of a federal health insurance component in his Social Security Act of 1935, before dropping it to avoid jeopardizing the bill’s passage. Fourteen years later, Harry Truman sent the House a bill that would offer health insurance to those age sixty-five and older, but it was blocked by an intractable Ways and Means Committee. Kennedy tried, too, sending a comparable bill to Capitol Hill in 1962, where it missed passage in the Senate by a few votes.
In each case, the American Medical Association (AMA) was the chief culprit in killing the legislation, spending millions to brand the concept as "socialized medicine," an ambiguous characterization that nonetheless made it intrinsically un-American. Conservatives also cast a wary eye. Actor Ronald Reagan, a darling of the growing conservative movement and soon-to-be California gubernatorial candidate, warned that such a program would "invade every area of freedom in this country" and would, in years to come, have Americans waxing wistful to future generations about "what it was like in America when men were free."
But sixteen years after Truman’s efforts were derailed by an unwilling Congress, Johnson believed "the times had caught up with the idea." On July 30, 1965, Johnson traveled to the Harry S. Truman Library and Museum in Independence, Missouri, where the eighty-one-year-old Truman, lean and bent with age, his wife, Bess, in tow, watched Johnson sign Medicare into law.
Proclaiming the thirty-third president the "real daddy" of Medicare, Johnson awarded President and Mrs. Truman the first two Medicare cards, numbers one and two. "He had started it all, so many years before," Johnson wrote of Truman later. "I wanted him to know that America remembered."
Excerpt from Indomitable Will: LBJ in the Presidency by Mark K. Updegrove
- Although usually called the Medicare bill, the actual title of the law is the Social Security Amendments of 1965. Medicare is Title XVIII of the Social Security Act; Medicaid is Title XIX.
- President Lyndon Johnson signed the amendments into law on July 30, 1965, at the Harry S. Truman Library in Independence, Missouri.
- Truman had tried to pass a bill to provide low-cost medical and hospital care for America’s elderly but had failed in his attempts. At the ceremony, Harry Truman was the first person to enroll in Medicare; he and his wife, Bess, received the first Medicare insurance cards.
- Budget funding for Medicare and Medicaid in fiscal year 1966, the first full year of Medicare’s operation, was approximately $2.2 billion.
- More than 2 and a half million Americans received hospital care covered by Medicare in the program’s first six months.
Some initial provisions of the program as passed in 1965:
- Program covered up to 90 days of hospital care, 100 days of nursing home care, and 100 home health care visits
- Persons over 65 could pay $3 a month for a voluntary health insurance plan covering 80 percent of doctor bills, laboratory tests, and related services.
- Language in the Medicare law required persons not covered by Social Security to swear that they were not members of any Communist organizations, a requirement that carried over from Section 210a (17) of the Social Security Act.
Click on individual photo to see it full size.
President Lyndon Johnson and President Harry S. Truman shake hands at the Medicare Bill Signing at Harry S. Truman Library and Museum in Independence, Missouri. LBJ Library photo by unknown, 34897-14. Taken July 30, 1965.
President Lyndon Johnson, President Harry S. Truman, and others walk through the Harry S. Truman Library and Museum during the Medicare Bill signing event. LBJ Library photo by Yoichi Okamoto, A986-26a. Taken July 30, 1965.
President Harry S. Truman and President Lyndon Johnson speaking. Medicare Bill signing event at the Harry S. Truman Library and Museum. LBJ Library photo by Yoichi Okamoto, A982-22a. Taken July 30, 1965.
To see more photos from the Medicare Bill signing, we recommend searching our photo archive and using "Medicare" in the search field. All photos are public domain and may be downloaded.
President Johnson signs Medicare & Medicaid into law. July 30, 1965.
The majority of this film is silent. Skip to 21:04 to view the signing and to 30:58 to hear audio from Johnson's remarks. Rights: public domain.
Full text: President Johnson's Remarks at the Medicare Bill Signing (July 30, 1965, The American Presidency Project)
Universal Newsreel: Medicare Bill Signing
Rights: public domain.
1964 Medicare Ad by the Democratic National Committee
This 1964 ad from the Democratic National Committee claims that Republican Sen. Barry Goldwater interrupted his vacation to vote against Medicare. Rights: public domain.
President Johnson's top domestic advisor, Joseph A. Califano, Jr., reveals how the president convinced the head of the American Medical Association to support Medicare.
Anecdote told during a Friends of the LBJ Library event on Thursday, March 26, 2015 at the LBJ Presidential Library.
Excerpt: Telephone conversation with President Johnson, Congressman Wilbur Mills, and Health, Education, and Welfare Assistant Secretary Wilbur Cohen on strategy to pass the Medicare Bill. March 23, 1965, 4:54 p.m.
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LBJ: When are you going to take it up?
Mills: I’ve got to go to the Rules Committee next week.
LBJ: You always get your rules pretty quickly though, don’t you?
Mills: Yeah, that’s right.
LBJ:...For God’s sake, let’s get it before Easter!...They make a poll every Easter...You know it. On what has Congress accomplished up till then. Then the rest of the year they use that record to write editorials about. So anything that we can grind through before Easter will be twice as important as after Easter.
[Mills gets off the line as Johnson continues the conversation with Cohen.]
LBJ: Now, remember this. Nine out of ten things that I get in trouble on is because they lay around. And tell the Speaker and Wilbur [Mills] to please get a rule just the moment they can.
Cohen: They want to bring it up next week, Mr. President.
LBJ: Yeah, but you just tell them not to let it lay around. Do that! They want to but they might not. That gets the doctors organized. Then they get the others organized. And I damn near killed my education bill, letting it lay around.
LBJ: It stinks. It’s just like a dead cat on the door. When a committee reports it, you better either bury that cat or get it some life in it...[to Mills as he gets back on the line:] For God’s sakes! “Don’t let dead cats stand on your porch,” Mr. Rayburn used to say. They stunk and they stunk and they stunk. When you get one out of that committee, you call that son of a bitch up before [our opponents] can get their letters written.
First Two Medicare Cards Given to President Harry S. Truman and Bess W. Truman by President Johnson
President Johnson's Daily Diary, July 30, 1965